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Monday, November 16, 2015

1666: Dr. Sydenham expands medical wisdom

If you were sick with asthma during the 16th, 17th and 18th centuries, who would you want to treat you? You had an option between a botanic physician and his natural remedies, or a licensed physician and his harsh remedies? Dr. T'homas Sydenham would try to convince you to see him, as opposed to some quack doctor.

Back in this era the common folk simply had a bleak image of licensed physicians. Virgil Vogel, in his book "American Indian Medicine," said this was even noted by men like Thomas Jefferson, Thomas Neville Bonner, and Dr. Oliver Wendell Holmes.

Vogel quoted Nevelle as saying: (1, page 114, 115)

The stubborn addiction of most physicians to mercury, bleeding, and calomel was responsible for widespread fear of the medical men and their medicines. (1, page 114, 115)

Vogel quotes Jefferson as saying:

"It is part of the medicine that I wish to see reform, an abandonment of hypothesis for sober facts, the first degree of value set on clinical observation, and the lowest on visionary theories."

He also quotes Holmes, who said:

Nature heals most diseases without help from the pharmaceutic art."

Thankfully, however, there were some well respected physicians, such as Dr. Thomas Sydenham in Britain and Dr. Benjamin Rush in American. Although, neither did anything to allay the public's bitter perception of the profession.

Sydenham had published his books in Britain, and there were no copies of them in America. Rush so respected the medical ideas of Sydenham that he self published Sydenham's book in America in 1809, complete with an introduction by himself. This book was aptly titled: "The Works of Thomas Sydenham M.D."

Historian Thomas Bradford said that Thomas Sydenham was born in 1624 at Winford Eagle, in Dorsetshire, England, to a father with a large fortune. He said that little is known about his early life. What id known is that he started at Oxford, but war interrupted his studies. Some say he ended up as a soldier in the Parliamentary army of 1642. In 1646 he returned to his studies at Oxford. (3, page 118)

Rush said he obtained a Bachelor's Degree in Physic (the art of medicine) at the University of Oxford in 1648 and in the process obtained "some medical knowledge. (2, page xvi)

A.J. Cain, in his 1999 book, said Sydenham wasn't content, and continued to travel abroad to further his education. He didn't obtain his M.D. until 1676 at Pembroke Hall at Cambridge. (4)

Bradford said he then moved on to the "celebrated" medical school at Montpelier. He received his degree of doctor at Ct Cambridge, and settled in Westminster, London, where he began his medical practice "sometime before 1661. He received his license from the College of Physicians of London." (3, page 118)

Historian Fielding Hudson Garrison said he is credited as reinstating the hippocratic art into medicine, which involved the art and skill of the physician more so than science and theory. He believed that "the mind is limited and fallible, and to it final causes must remain inscrutable. Scientific theories are, therefore, of little value to the practitioner since, at the bedside, he must rely upon his powers of observation and his fund of experience." (5, page 270)

Garrison said he was friends with fellow Englishmen Robert Boyle and John Locke. However, and interestingly, it is generally believed he did not know of the works of many of his contemporaries, such as Andreas Vesalius, William Harvey, Marcello Malpighi, and John Mayow. Among his favorite books were Hippocrates and Don Quixote. (5, page 269)Rush said that Sydenham was well aware of the fact that his continued research into physick elevated him above his peers. Regardless, he continued to have respect for the wisdom of those who came before him. To show this, Rush told the story of one of his meetings with Sir Richard Blackmore, who was physician to King William III and a famed writer and poet. (9). Rush said:

It is the general opinion, that he was made a physician by accident and necessity, and sir Richard Blackmore* reports, in plain terms, that he engaged in practice without any preparatory study, or previous knowledge, of the medical sciences; and affirms, that when he was consulted by him what books he should read to qualify him for the same profession, he recommended Don Quixote.

That he recommended Don Quixote to Blackmore, we are not allowed to doubt; but the relater is hindered by that self'love, which dazzles all mankind, from discovering that he might intend a satire very different from a general censure of all the ancient and modern writers on medicine, since he might perhaps mean, either seriously or in jest, to insinuate, that Blackmore was not adapted by nature to the study of physic, and that, whether he should read Cervantes or Hippocrates, he would be equally unqualified for practice, arid equally unsuccessful in it.

Whatsoever was his meaning, nothing is more evident than that it was a transient sally of an inclination warmed with gaiety, or the negligent effusion of a mind intent on some other employment, and in haste to dismiss a troublesome intruder; for it is certain that Sydenham did not think it impossible to write usefully on medicine, because he has himself written upon it; and it is not probable that he carried his vanity so far, as to imagine that no man has ever acquired the same qualifications besides himself. He could not but know that he rather restored than invented most of his principles, and therefore'could not but acknowledge the value of those writers whose doctrine he adopted and enforced. (1, xvi-xvii)

Sydenham wrote a lot about his ideas on the medical profession of his time, and he had several books published in Britain. None of these survive, so all that we have left of his works is the book published by Rush. (3, page 118)

Sydenham believed in the four humors of Hippocrates, and that diseases were caused by some form of peccant matter (or "morbific particles") in the air that were inhaled, and disease states were the result of the body attempting to expectorate the peccant matter.

Dr. Syndenham describes diseases as follows:

DISEASE, in my opinion, how prejudicial so ever its causes may be to the body, is no more than a vigorous effort of nature to throw off the morbific matter, and thus recover the patient. For as God has been pleased so to create mankind, that they should be fitted to receive various impressions from without, they could not, upon this account, but be liable to different disorders; which arise either from such particles of the air, as having a disagreement with the juices, insinuate themselves into the body, and mixing with the blood, taint the whole frame; or from different kinds of fermentations and putrefactions of humours detained too long in the body, for want of its being able to digest, and discharge them, on account of their too large bulk, or unsuitable nature.(2, page 1)

In the introduction to the book, Dr. Benjamin Rush (1746-1813) wrote the following:

"The works of Dr. Syndenham are singular, in being alike, celebrated and neglected by modern physicians. They owe their fame to the invaluable truths that are contained in them; and the neglect with which they have been treated, to certain errors, which have been refuted by modern discoveries and improvements in medicine." (2, page III)

Dr. Rush did little to improve upon the image of the profession, as his methods differ by only a slight degree from those of Sydenham. For example, Dr. Rush did not believe that "morbific matter" was the cause of disease, nor that the expulsion of this "morbific matter" would cure the disease. (2, page IV)

For the most part, however, Rush supported the medical views of Sydenham. Dr. Rush said:

To enumerate the many truths that are contained in the following work, would be to transcribe, with the exception of a few pages, nearly every part of it. His histories of acute diseases; his details of the laws of epidemics; his intuitive discernment of old diseases, entangled in new ones; his defence of cool air, and pf depleting remedies, to which millions owe their lives; his sagacity in discovering the precise time, and manner of administering his remedies, and the difference of his practice in the same disease in different seasons, constitute a galaxy of medical knowledge, and mark that rare assemblage of discriminating and combining talents, which have elevated him above the claims of the century and nation in which he lived, and rendered him the physician of all ages and countries. The same talents, employed upon subjects of more general and popular inquiry, would probably have placed him upon the same grade with sir Isaac Newton, in a scale of human intellect... Indeed, so convinced have later times been of the validity and accuracy of his descriptions, that they are considered as the unrivalled delineations of nature; so universally have they been esteemed for their exactitude and truth, that poets never made freer use of, or stole more from Homer, Pindar, or Virgil; satyrists from Juvenal, Persius, or Horace; orators from Demosthenes, Quintilian, or Cicero; nor dramatists from Shakespeare, than physicians have from Sydenham." (2, page VI)

Dr. Rush believed all medical students should study Sydenham, who believed it was the job of the physician to offer medicine to guide the body in its attempt to rid the body of the peccant material. For example, Sydenham said of gout:

What is the gout, but the contrivance of nature to purify the blood of aged persons, and, as Hippocrates phrases it, to purge the recesses of the body? And the same may be said of many other diseases, when they are perfectly formed. (2, page 1)

What is impressive here is that the same philosophies of medicine written about by Hippocrates in 400 B.C. were still inculcated in the 17th century, and even still during the 18th century. This, in essence, should explain some of the harsh remedies -- such as purging and bleeding to expel some peccant matter -- amid the licensed medical profession of the 17th and 18th centuries.

Amid a society that was growing skeptical of the harsh remedies of the licensed medical profession, it only makes sense that a gullible populace would seek the natural alternatives offered by the root and herb doctors, or the botanic physicians.
Chances are, however, that if you had access to an esteemed gentleman physician such as Dr. Sydenham, you'd probably have faith in his remedies. Of this, Dr. Rush said:

What was his character as a physician, appears from the treatises that he has left, which it is not necessary to epitomize or transcribe; and from them it may likewise be collected, that his skill in physic was not his highest excellence; that his whole character was amiable ; that his chief view was the benefit of mankind, and the chief motive of his actions the will of God, whom he mentions with reverence, well becoming the most enlightened and most penetrating mind. He was benevolent, candid, and communicative, sincere and religious; qualities which it were happy if they would copy from him, who emulate his knowledge, and imitate his methods. (2, page xx)

He was among the most well respected physician of his era, influencing medicine well into the next century. By his method of studying diseases by direct examination of the living, he is often cited as the founder of clinical medicine. By his belief that it was important to understand diseases in order to better control them, he is often cited as the father of epidemiology. (6)(7)(5, page 270)He also lived in a era where the various elements of science were first being categorized. He believed, as Garrison said, "that each disease belonged to a certain definite species, which could be described and classified as a botanist describes plants. (5, page 270) Garrison said:

His theory of medicine was simple. The human mind is limited and fallible, and to it final causes must inscrutable. Scientific theories, therefore, are of little value to the practitioner since, at the bedside, he must rely upon his powers of observation and his fund of experience. (5, page 269-270)

Perhaps due to his Puritan beliefs, he rejected pathological anatomy, or using the microscope to learn more about the causes of internal diseases. He believed it was better for a physician to assess his patient and use his senses to determine proper treatment, as opposed to trying to learn about internal causes. (8)

Bradford said, "His model was Hippocrates, and he thought that we should follow nature; he differed from him in attempting to arrest the natural course of disease by giving specifics," said Bradford. (8)(3, page 118)

He continued to practice until 1789 when he died at the age of 65. He was so esteemed by his fellow British physicians that "a monument was erected to him by the college of physicians... (posthumously) he was called the English Hippocrates," said Bradford. (3, page 118)

Sydenham, Thomas, M.D., "The works of Thomas Sydenham, M.D., on acute and chronic diseases, with their histories and mode of cure, with notes intended to accommodate them to the present state of medicine, and to the climate and diseases of the United States, by Benjamin Rush, M.D., professor of the Institutes and Practice of Medicine, and of Clinical Practice, in the University of Pennsylvania," 1809, Philadelphia, Published by Benjamin and Thomas Kite.

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History maketh a young man to be old, without either wrinkles or grey hairs; privileging him with the experience of age, without either the infirmities or inconveniences thereof. Yea, it not only maketh things past, present; but enableth one to make a rational conjecture of things to come. For this world affordeth no new accidents, but in the same sense wherein we call it a new moon, which is the old one in another shape; and yet no other than that hath been formerly. Old actions return again, furbished over with some new and different circumstances. (Thomas Fuller in the Epistle Dedicatory to his The History of the Holy War, March 6th, 1639).

About Me

John Bottrell is a respiratory therapist. He's a featured asthma and COPD writer for asthma.net and copd.net. He's the creator and occasionally writer for Respiratory Therapy Cave, the #1 respiratory therapy blog. He's an avid historian and creator of Asthma History. His blog posts have been featured in various newspapers, such as the Chicago Tribune. He has previously been a featured asthma/COPD writer for Healthcentral.com and asthma writer for Answers.com.